System combining automated searches of radiologic images, accession number assignment, and interfacility peer review

ABSTRACT

A system that helps facilitate the creation of more comprehensive official radiological reports by remotely accessing a patient&#39;s prior outside imaging studies along with official radiological reports through a cloud server for comparison to current studies performed at a medical institute. The system includes universal interface software that will allow for previous patient studies to be automatically pulled for direct comparison by using advanced automatic tagging techniques. Additionally the universal interface software allows for more efficient accession number assignment when official second opinions are requested, and a means for interfacility peer review.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Application No.62/151,521, filed Apr. 23, 2015.

FIELD OF THE INVENTION

The present invention relates to a system for creating morecomprehensive radiologic reports by accessing prior patient studies viaa cloud system, more efficient methods for accession number assignment,and interfacility peer review.

BACKGROUND OF THE INVENTION

One of the most important diagnostic skills that radiologists acquireduring their training is learning the value of prior comparisons wheninterpreting imaging studies in order to generate useful reports for thereferring clinical service. Unfortunately past radiological images areoften not available at the medical institute because patients often havestudies done at several different medical institutes. When past imagesare not available recommendations may be made for further unnecessaryimaging studies or procedures leading to increased cost, procedurerelated complications and inaccurate diagnoses. Unnecessary imagingstudies and procedures are less likely to occur at a large integratedhealth system where the patient has a significant image historyaccessible to the radiologist through the health system's PACS. However,when a patient has had multiple imaging studies at multiple outsidemedical institutes, it is not always possible to be aware of what paststudies and images have been taken, which often relies on the imagesbeing placed on a digital imaging storage media, such as CDs orradiological film and then mailed to the requesting facility ordelivered by hand, potentially delaying critical diagnoses. There is aneed to build patient imaging libraries across medical institutes. Thereis also a need to tag the images in the patient library that allowsradiologists to quickly locate and access past images for comparisonwith current images.

Cloud server technology has provided a solution to the problem ofcentralizing a patient's imaging studies, making them more easilyaccessible from remote sites. The number of imaging studies beingperformed continues to increase exponentially. This is compounded by thefact that patients are living longer, but are not necessarily healthierand the Affordable Care Act has made healthcare more accessible. Thereis a need for more efficient means of searching through libraries ofimaging studies in the generation of more complete radiological reportsespecially when outside studies are being accessed through cloud forcomparison.

As medical facilities become more integrated through the use of cloudtechnology, interfacility peer review could conceivably become arequirement by the American College of Radiology and the JointCommission on Accreditation of Healthcare Organizations. Peer review ismost commonly used for assessing performance in terms of diagnosticability among radiologists. Ultimately the goal of peer review is toreduce interpretive errors and improve care. Currently the AmericanCollege of Radiology and the Joint Commission on Accreditation ofHealthcare Organizations requires that medical facilities participate inpeer review to maintain accreditation. A radiologist at theirinstitution reviews a set number of imaging studies interpreted by hisor her peers, and for each reviewed imaging study a case reviewsubmission page is generated which will have options of concur, disagree(difficult diagnosis), disagree (diagnosis should be made most of thetime), disagree (diagnosis should be made every time), and a commentssection for explaining the findings. Although there are no currentrequirements for peer review of outside interpretations, conceivably,there will be a need for radiologists to peer review colleagues fromoutside facilities.

An additional problem that arises with the decentralization of sharingradiological images using the traditional methods of transferring pastimages on a storage medium is often referred to as a “curbsideconsultation.” The term “curbside consultation” refers to an unofficialconsultation obtained by healthcare professionals usually from anotherhealth care professional, such as a radiologist on staff at the medicalinstitute. Curbside consultations with regard to outside imaging studiesare often requested by physicians in one department, such as anemergency room physician or surgeon, to a radiologist on staff. In suchscenarios radiologists are often requested to provide a quick read ofthe diagnostic image without creating a documented report. This can beproblematic for radiologists because the requesting physician will thenplace notes in the patient's file concerning what the radiologist toldthem. This can create several problems. First, the only written recordof the radiologist is the hearsay opinion of what the requestingphysician heard, which may or may not be entirely accurate. Also therequesting physician does not have any written record to refer back toin case they misunderstood the radiologist. This creates a liabilityburden for the radiologist. Second, the radiologist does not receive anycompensation for the “curbside consultation” which is not equitablegiven the degree of malpractice liability that can arise from a curbsideconsultation. Third, for the time spent on such consults the radiologistwill not receive the appropriate relative value units or RVUs which areused to measure individual physician productivity. However, curbsideconsultations can be very important, especially in emergency situationswhere time is of the essence. The rate limiting step in creating anofficial radiologic report of an outside imaging study is the assignmentof accession numbers. Current methods for accession number assignment asit relates to curbside consultation are inefficient in that ancillarystaff coordination is required which can delay critical diagnoses. Thereis a need for more efficient means of assigning accession numbers tooutside imaging studies so official radiologic reports can be createdduring curbside consultation.

SUMMARY OF THE INVENTION

The present invention relates to a system for cloud-based radiologicalimage comparisons and a method of generating reports therefrom. Thesystem includes the step of providing universal interface software forstandardizing all information uploaded to a cloud server accessiblethrough internet via a secure connection. The cloud server is providedand operates the universal interface software having at least onepatient library located on the cloud server. The at least one patientlibrary is for a specific patient and is used for storing at least oneprevious patient study prepared by a first medical institute as part ofthe at least one patient library. The at least one previous patientstudy includes written patient information, including patient name anddate of study and is created using the universal interface software inorder to ensure compatibility with systems accessing the cloud server.

The at least one previous patient study also includes at least onepatient diagnostic image, a written report pertaining to the at leastone patient diagnostic image, and at least one image procedure tagpertaining to how the diagnostic image was obtained. There is also atleast one image view tag pertaining to the viewpoint of the at least onepatient diagnostic image, an automatically assigned accession number,and an automatically assigned universal medical record number associatedwith the at least one previous patient study. The at least one previouspatient study also contains automatically assigned anatomical sub-tags.The universal interface software is programmed to assign the anatomicalsub-tags based on the at least one image procedure tag and the at leastone image view tag. The universal interface software is also programmedto perform a keyword tagging step where the universal interface softwarein combination with a computer reads a written report associated with apatient study and then generates keyword tags by recognizing anatomicallanguage in the written report of the comparison patient study.

The system further includes a step of providing a second medicalinstitute operating the universal interface software, which is capableof communicating with the cloud server. The second medical institute hasat least one radiological diagnostic image device, at least oneworkstation, a picture archiving and communication system for storingpatient images and reports created or downloaded for review at thesecond medical institute. At the second medical institute at least onecomparison patient diagnostic image is created using the at least oneradiological image device. The at least one comparison patientdiagnostic image is then uploaded to the picture archiving andcommunication system at the second medical institute.

Next the step of using the at least one workstation at the secondmedical institute takes place where the at least one workstation is usedto access the at least one comparison patient diagnostic image locatedon the picture archiving and communication system at the second medicalinstitute. The step of tagging the at least one patient comparisondiagnostic image takes place by a user of the at least one workstationusing a graphical user interface and the universal interface software toselect at least one image procedure tag pertaining to the type of imageand how it was obtained. Next a user using the graphical user interfaceselects at least one image view tag pertaining to the viewpoint of theat least one patient diagnostic image. The universal interface softwareautomatically assigns anatomical sub-tags, an accession number, and auniversal medical record number to the comparison patient study. Theuniversal interface software is programmed to assign the anatomicalsub-tags based on the at least one image procedure tag and the at leastone image view tag.

Next a user of the at least one workstation performs the step ofreviewing the at least one patient comparison diagnostic image andidentifies an abnormality in the at least one comparison patientdiagnostic image that requires further investigation.

Next is the step of accessing the at least one patient library on thecloud server using the at least one workstation being controlled by auser. The universal interface software on the at least one workstationat the second medical institute sends a request to the cloud server tosearch the at least one patient library for any at least one patientdiagnostic image containing the same anatomical sub-tags as the at leastone comparison patient diagnostic image. Next at least one previouspatient study that includes the at least one patient diagnostic imagematching the request is downloaded from the cloud server to the picturearchiving and communication system of the second medical institute. Theuniversal interface software on the at least one workstation at thesecond medical institute automatically links the universal medicalrecord number from the previous patient study to the universal medicalrecord number of the comparison patient study.

Next a comparison patient study is created with a written reportcomparing the at least one comparison patient diagnostic image and theat least one previous patient study downloaded from the cloud server.During this step the at least one patient diagnostic image from the atleast one previous patient study is downloaded from the cloud server andthe at least one comparison patient diagnostic image are organized intoa timeline on the at least one workstation at the second medicalinstitute. Next the at least one patient diagnostic image from theprevious patient study and the at least one comparison patientdiagnostic image are reviewed in a side-by-side comparison to conductfurther investigation of the abnormality noted in the at least onecomparison patient diagnostic image. The comparison patient studyincludes a review of the abnormality noted in the at least onecomparison patient diagnostic image and the presence or absence of anabnormality in the at least one previous patient study downloaded fromthe cloud server. Lastly the step of uploading the comparison patientstudy from the second medical institute to the cloud server and savingthe comparison patient study to the at least one patient library on thecloud server takes place.

Areas of applicability of the present invention will become apparentfrom the detailed description provided hereinafter. It should beunderstood that the detailed description and specific examples, whileindicating the preferred embodiment of the invention, are intended forpurposes of illustration only and are not intended to limit the scope ofthe invention.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention will become more fully understood from thedetailed description and the accompanying drawings, wherein:

FIG. 1 is a schematic diagram of a system for cloud based radiologicalimage comparisons and method of generating reports.

FIG. 2 is a schematic diagram showing a workstation at a medicalinstitute in accordance with the present invention.

FIG. 3 is a screenshot of a work list monitor.

FIG. 4 is a screenshot of a patient history timeline, image proceduretag, and image view tag selection boxes.

FIG. 5 is a front perspective view of the first image monitor and secondimage monitor, with various interface devices of the workstation.

FIG. 6 is a screenshot of a sample official review window.

FIG. 7 is a portion of a flow chart showing the various steps of themethod of operating the system in accordance with the present invention.

FIG. 8a is a portion of a flow chart showing the various steps of themethod of operating the system in accordance with the present invention;

FIG. 8b is a portion of a flow chart showing the various steps of themethod of operating the system in accordance with the present invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The following description of the preferred embodiment(s) is merelyexemplary in nature and is in no way intended to limit the invention,its application, or uses.

Throughout this specification the following terms are used, which aredefined as follows. The term “medical institute”, whether called “firstmedical institute”, “second medical institute” or just “medicalinstitute” is used to refer to any type of organization or individualthat prepares patient studies or uploads patient diagnostic images andincludes individual physicians, physician practices, hospitals, researchinstitutes, or any other individual or organization concerned withpreparing and uploading information into the at least one patientlibrary, associated with a specific patient.

The term “patient study” or “patient studies” also including the terms“previous patient study”, “previous patient studies”, “comparisonpatient study”, “comparison patient studies”, “manual patient study” and“manual patient studies” include written patient information includingmedical record numbers, patient name and date of study and one or morepatient diagnostic images; each of these terms may or may not include awritten report pertaining to the patient diagnostic images, one or moreimage procedure tags pertain to nature of the image and how it wasobtained, one or more of view tags pertaining to the viewpoint of thepatient diagnostic images, medical record numbers and automaticallyassigned anatomical sub-tags and keyword tags. For example, a “manualpatient study”, which is described as being obtained from a compactdisc, might not contain any other information than the medical recordnumber, patient name and date of study along with just diagnostic imagesand no other written reports. The term “patient library” refers to agroup of one or more patient study files that pertain to a specificindividual patient.

The terms “patient diagnostic image”, “patient diagnostic images”,“radiological diagnostic image” and “radiological diagnostic images” aredefined herein to include one or more diagnostic images prepared fromvarious diagnostic equipment, including but not limited to x-rays,magnetic resonance imaging (MRI) data or images, computerized tomography(CT) scans, positron emission tomography (PET), mammograms (MG),computed radiography (CR), ultrasound data or images or any othermedical diagnostic images or data, etc. The images can be taken frommultiple medical diagnostics devices and it is also possible that theyare taken from different views or comprise a series of images or datablocks.

The term “picture archiving and communication system” will at times bereferred to by the acronym PACS and is defined to be a server ormainframe located at one of the medical institutes for localized storageof at least one patient diagnostic image and patient study files at amedical institute.

The term “accession number” is defined to be a unique identifier numberassigned to a specific order or set of diagnostic images that becomepart of a patient study and are subsequently saved to the PACS and orcloud server. The accession number is used for generating bills forservices as well as cataloging the patient study and associated images.

The term “medical record number” includes the term “universal medicalrecord number” and is defined to be a unique number given to a patientto identify that patient out of a group of patients.

Referring now to all the figures, with particular reference to FIG. 1shows a system 10 overview for preparing and uploading radiologicdiagnostic images to a cloud server 12. The cloud server 12 includes amainframe 13 and data storage unit 14, which can be separate units or asingle unit. Both the mainframe 13 and data storage unit 14 arehereafter collectively referred to as the cloud server. The data storageunit 14 is the portion of the cloud server 12 that stores patientlibraries that pertain to a specific patient. Each patient libraryincludes at least one previous patient study that includes writtenpatient information including automatically assigned medical recordnumber, accession number, patient's name, date of the study, at leastone patient diagnostic image, and possibly a written report pertainingto the at least one patient diagnostic image, at least one imageprocedure tag, at least one image view tag, and automatically assignedanatomical sub-tags and keyword tags.

Each patient study located on the cloud server 12 is uploaded to thecloud server 12 from a couple of different sources. A first source is afirst medical institute 16 capable of uploading and downloading patientstudies to the cloud server 12. In order to properly upload the patientstudy the first medical institute 16 uses pre-loaded universal interfacesoftware operating on a picture archiving and communication system(PACS) 20 or on the workstation 22, 22′. It is also within the scope ofthis invention for the cloud server 12 to provide a virtual workstation27′ to the first medical institute 16 either through the PACS 20 ordirectly to the workstation 22, 22′ by uploading a web based portal thatincludes the universal interface software. The use of the universalinterface software and the virtual work station 27′ ensures that anydata including patient studies uploaded from the first medical institute16 to the cloud server 12 are uploaded using a universal interfacesoftware format that will be consistent across the system 10.

The first medical institute 16 has one or more radiological diagnosticimage devices 18 that are used to create images and upload them to apicture archiving and communication system 20 located at the firstmedical institute 16. Within the first medical institute 16 there areworkstations 22, 22′ that communicate with the PACS 20. The workstations22, 22′ are able to retrieve the images stored on the PACS 20, whichwere taken using the radiological diagnostic image devices 18. It isalso within the scope of this invention for the workstations 22, 22′ tocommunicate directly with the cloud server 12, which could eliminate theneed to have a PACS 20 at the first medical institute 16.

Another source of diagnostic image data is provided by a compact disc(CD) 24 that is read by the workstation 22, 22′ and the images from thecompact disc 24 are uploaded from the workstation 22, 22′ to the picturearchiving and communication system 20 or directly to the cloud server12. The workstation 22, 22′ is used to prepare or analyze the diagnosticimages from the diagnostic image device 18 or the images from thecompact disc 24, into a patient study file created on the workstation22, 22′, that will include a written report pertaining to the at leastone patient diagnostic image that was reviewed at the workstation 22,22′. The workstation 22, 22′ is used to command the PACS 20 to uploadthe previous patient study file to the cloud server 12 using a secureinternet connection or the workstation 22, 22′ can be configured todirectly upload the previous patient study to the cloud server 12.

FIG. 1 also shows another source of diagnostic image data or patientstudy data where a compact disc (CD) 25 is uploaded onto the cloudserver 12 directly by a patient at his or her personal computer 26. Thepatient can be granted access to his or her patient library located onthe cloud server 12 using a personalized login and password associatedwith their universal medical record number that is automaticallyassigned to their patient library using the universal interface softwarelocated on the cloud server 12. In order to properly upload the patientstudy from the compact disc 25 the cloud server 12 provides a virtualworkstation 27 on the personal computer 26 by uploading a web basedportal that includes the universal interface software, in order toensure that any data uploaded from the compact disc 25 from the personalcomputer 26 to the cloud server 12 is uploaded using a universalsoftware format. This will ensure that any data including patientstudies and diagnostic images uploaded from the personal computer 26will be in a format that will be accessible and readable by any medicalinstitute that uploads the information from the cloud server 12.

It is also within the scope of this invention for the personal computer26 to not be operated by a patient, but rather by a physician or someother medical professional from his or her home or office computer. Itis sometimes necessary for physicians to have remote access to patientstudies. One feature of the present invention is that having patientstudies located on the cloud server 12 allows a physician quick remoteaccess to a patient study file from the server 12, especially when thephysician is unable to see a patient in person at a medical institute.Such ability will allow a physician to be able to provide better patientcare and also help other medical personnel who have immediate access tothe patient.

Another source of diagnostic image data and patient studies is a secondmedical institute 28 having its own picture archiving and communicationsystem 30 (PACS) capable of communicating with the cloud server 12 inorder to upload and download patient studies to and from a patientlibrary located on the data storage device 14 connected to the cloudserver 12. The second medical institute 28 also has radiologicaldiagnostic image devices 32 connected to the picture archiving andcommunication system 30 of the second medical institute 28. Multipleworkstations 34, 34′ are connected to the PACS 30 of the second medicalinstitute 28. Workstations 34, 34′ access patient diagnostic imagesstored on the PACS 30, which were created from the radiologicaldiagnostic image devices 32 at the second medical institute 28. Theimages can also be uploaded to the cloud server 12 using theworkstations 34, 34′. The workstations 34, 34′ are also used to reviewand upload patient study files and manual patient diagnostic images froma compact disc 36. When the manual patient studies are uploaded from thecompact disc 36 using the workstations 34, 34′ at step 35(FIG. 8A) themanual diagnostic images are automatically uploaded to the PACS 30 andare immediately assigned a medical record number and accession numbereither at the individual workstations 34, 34′ or at the PACS 30. Thiseliminates the need to involve ancillary staff for accession numberassignment when a radiologist at workstation 34, 34′ or PACS 30 isapproached by an emergency room physician, surgeon, etc., for a curbsideconsultation regarding the manual patient diagnostic images from compactdisc 36. The manual patient studies are then uploaded from theworkstation 34, 34′ to the PACS 30 of the second medical institute 28and can also be uploaded to a patient library located at the cloudserver 12. This allows for comparison patient studies to be preparedbased off of diagnostic images brought in from the compact disc 36,which can subsequently be uploaded to the PACS 30 and cloud server 12from the second medical institute 28.

It is also within the scope of this invention for the cloud server 12 toprovide a virtual workstation 27 to the second medical institute 28either through the PACS 30 or directly to the workstation 34, 34′ byuploading a web based software component that includes the universalinterface software. The use of the universal interface software and thevirtual work station 27 ensures that any data including patient studiesand diagnostic images are uploaded from the second medical institute 28to the cloud server 12 using a universal software format. Additionallyany data uploaded from the compact disc 36 at the second medicalinstitute 28 will also be uploaded to the cloud server 12 using theuniversal interface software.

During review of the manual patient diagnostic images as part of asecond opinion or the diagnostic images created at the second medicalinstitute 28, abnormalities in the images might be noticed.Abnormalities are generally something in the diagnostic image thatwarrants further investigation or study and can include suspected tumorsor simply be the result of the radiological image such as a shadow orunclear image, all of which might require further investigation. If anabnormality is noticed a physician at the workstation 34, 34′ may beginto create a comparison patient study where the physician will designatethe patient diagnostic image from the second medical institute 28 as acomparison patient diagnostic image. The physician will then use theworkstation 34, 34′ to query the cloud server 12 either directly orthrough the PACS 30 of the second medical institute 28. During the queryprocess the physician will request the server to search the patientlibrary located on the cloud server 12 and request the cloud server 12to search the patient library for any patient diagnostic imagecontaining the same image view tags, image procedure tags, anatomicalsub-tags and keyword tags as the comparison patient diagnostic image andthen download the previous patient study which includes the matchingdiagnostic image from the cloud server 12 to the PACS 30 of the secondmedical institute 28.

Another aspect of the invention allows a physician or user of theworkstation 34, 34′ at the second medical institute 28 to conductnon-official communication 39 to a physician at a workstation 22, 22′located at the first medical institute 16. The non-officialcommunication 39 does not get recorded in the cloud server 12.Non-official communication 39 can include email messages and is intendedto be directed more toward social discourse either about the diagnosticimages for the patient or regarding other non-medical matters. Thepurpose of non-official communication 39 is to provide physicians with aless formal avenue for communication in instances where thecircumstances surrounding a particular case do not warrant an officialpeer review.

While FIG. 1 shows two medical institutes 16, 28 and a single personalcomputer 26 and communication with the cloud server 12, it is within thescope of this invention for a greater or lesser number of personalcomputers and medical institutes to be in communication with the cloudserver 12.

Referring now to FIG. 2, a layout of the workstation 34, 34′ is shownand described. The workstation 34, 34′ is identical to the workstation22, 22′ at the first medical institute 16. Therefore the description ofthe workstation 34, 34′ described in FIG. 2 will also apply to theworkstation 22, 22′ at the first medical institute 16. Each workstation22, 22′, 34, 34′, includes a first image monitor 38 and second imagemonitor 40 that are connected to a tower 42 which is a high-performancecomputer that communicates with the respective PACS 20, 30. The tower 42is also used to communicate with the cloud server 12, either through thePACS 20, 30 or directly with the cloud server through a secure internetconnection.

The first image monitor 38 and second image monitor 40 are highresolution monitors having at least 3 megapixel resolution or above andthe first image monitor 38 and second image monitor 40 are typicallyorganized or arranged in a side by side manner in order to assist thephysician in comparing images as well as being able to scroll through alist of images or studies that are organized on a timeline that isdiscussed below in greater detail.

The workstation 22, 22′, 34, 34′ also includes various interface devices44 which include a dictaphone 46 that allows for a user of theworkstation to dictate written reports, a keyboard 48 used for typinginputs, and a mouse 50 that is used to control a graphical userinterface that moves between the various monitors of the workstation.The workstation 22, 22′, 34, 34′ also includes a voice recognitionmonitor 52 that is connected to and receives inputs from the tower 42and is used to allow a physician to use or control the operation andinputs received from the dictaphone 46 and other various interfacedevices 44 in order to prepare a written report. During preparation of awritten report the physician can view the voice recognition monitor 52and see the written report that he or she is dictating and can alsomanually input text using the keyboard 48 and options from the mouse 50.In an alternate embodiment of the invention, the voice recognitionmonitor 52 is also where a physician can use the mouse 50 and itsgraphical user interface to select and tag various images displayed onthe first image monitor 38 and second image monitor 40. The tagging ofthe images are discussed in greater detail below. However it is withinthe scope of this invention for the steps of tagging and preparing awritten report to be conducted directly on the first image monitor 38 orsecond image monitor 40 and not have a voice recognition monitor 52.

The workstation 22, 22′, 34, 34′ also includes a work list monitor 54connected to the tower 42 and a cloud monitor 56 connected to the tower42. Referring now to FIG. 3 a sample screenshot of the work list monitor54 is shown. The worklist monitor 54 displays the current list ofdiagnostic images recently prepared at the medical institute that needto be reviewed by a physician so that a formal written report andpatient study can be prepared. The information on the work list monitor54 includes information pertaining to the patient's name and the list ofthe various diagnostic images contained on the PACS 20, 30 that arewaiting to be reviewed.

The cloud monitor 56 displays information obtained from the cloud server12. The cloud monitor 56 can be used to show or confirm that patientstudies have been uploaded to the cloud server or a physician may checkthe cloud server 12 to identify and download the previous patientstudies from other medical institutes. Essentially the cloud monitor 56is used to interface with the cloud server 12 so that a physician cansend commands from the medical institute to the cloud server 12 inaccordance with various aspects of the present invention.

The system 10 and its various components, including the workstations 22,22′, 34, 34′ provide many different benefits such as allowing forpatient study reports, including diagnostic images to be uploaded to thecloud server 12 where they can then be accessed by other medicalinstitutes. The features of the system 10 and the method of operatingthe system 10 allow for the patient studies to be uploaded using theuniversal interface software to ensure that the diagnostic images andpatient studies have a consistent format that is compatible across thevarious medical institutes. Additionally the system 10 and method allowsfor comparison patient studies to be conducted by examining previouslyuploaded patient studies and diagnostic images, thus saving time,improving patient care and eliminating needless additional studies sinceabnormalities or other areas of further investigation can be checked byreviewing the patient's previous studies located on the cloud server 12.Another benefit of the present invention is that the system 10 and itsmethodology allows for peer review and non-official communication to beconducted between physicians at different medical institutes, whichencourages the sharing of information and communication betweenphysicians with the common goal of providing better patient care.

Referring now to FIGS. 7, 8A, and 8B are flowcharts of a method forusing the system 10 in order to perform a comparison patient study inaccordance with one aspect of the present invention. During such amethod at a creating diagnostic image step 58 a physician or technicianat the first medical institute 16 creates at least one patientdiagnostic image 86 of a patient using one of the radiologicaldiagnostic imaging devices 18. Typically a patient study will involveseveral images being taken, therefore it is within the scope of thisinvention for more than one diagnostic image to be prepared. The patientdiagnostic image 86 is simultaneously uploaded to the PACS 20 of thefirst medical institute 16, also at this time the universal interfacesoftware will assign an accession number to the patient diagnostic image86 and coordinate the medical record number with the patient diagnosticimage 86. Both the accession number and medical record number will beincorporated into the patient study. The accession number allows for allof the services and procedures, including the radiologist's writtenreport to be billed under the assigned accession number. Then at anaccessing step 60 the same physician or different physician uses one ofthe workstations 22, 22′ at the first medical institute 16 to access theone or more patient diagnostic images 86 located on the PACS 20, whichpertain to the patient. The physician reviews the at least one patientdiagnostic image 86 and then prepares a written report using thedictaphone 46, keyboard 48, mouse 50 and monitors 38, 40, 56, 54, 52described with regard to FIG. 2 above regarding the patient diagnosticimage.

Also referring to the screenshot shown in FIG. 4, a tagging step 62occurs where the at least one diagnostic image is tagged by thephysician or user of the workstation 22, 22′ using a graphical userinterface 77 to select at least one image procedure tag 90 pertaining tohow the diagnostic image was obtained and at least one image view tag 92pertaining to a viewpoint or location on the anatomy of the at least onediagnostic image 86. The tagging step 62 is carried out by the physicianor user using the mouse 50 and drop-down menus presented on the firstimage monitor 38, second image monitor 40, voice recognition monitor 52,work list monitor 54, or cloud monitor 56 wherein a graphical userinterface 77 is used to carry out the tagging step 62. Examples ofdifferent image procedure tags 90 include, but are not limited to thefollowing types of diagnostic devices or modalities such as X-ray, CTscan, MRI, positron emission tomography (PET), mammograms (MG), computedradiography (CR) etc. Examples of image view tags 92 include but are notlimited to the following axial, sagittal reformats, coronal reformats,anterior/posterior, lateral and oblique, right, left, etc. Next theuniversal interface software at an automatic sub-tagging step 64 willautomatically assign anatomical sub-tags 94 that are based on the imageprocedure tag 90 and view tag 92 selected by the physician or userduring the tagging step 62. The automatically assigned anatomicalsub-tags 94 include but are not limited to the following anatomicalsub-tags pertaining to the different portions of the anatomy that aparticular image view and image procedure would also include such asthoracic, cranial, abdominal, pelvic, femur, tibia, spine, heart, lung,intestine, etc. For example a diagnostic image pertaining to the upperchest cavity focusing on the shoulder, would also be known to includeportions of the heart, upper lung, ribs, cervical portion of the spinalcolumn and possibly the lower mandible or jaw of the patient, each ofwhich would be an anatomical sub-tag automatically tagged to thediagnostic image. This eliminates the need to have a user of the systemlog in all the anatomical sub-tags, which would be tedious and alsodepend on a user properly sub-tagging the image.

Generally the use of automatically assigned anatomical sub-tags 94,image view tags 92 and image procedure tags 90 in connection with eachdiagnostic image 86 that is part of a previous patient study 70associates or tags words or terms with what is shown in the image. Thismakes it possible so that future searches of the patient library will beable to identify the diagnostic image and associated study by having tagwords that match the search terms or words. Also using prepopulatedimage procedure tags, image view tags and automatically assignedsub-tags provides a common software nomenclature for all patient studieson the cloud server 12. The common nomenclature also assists users ofthe cloud server so they can accurately identify appropriate diagnosticimages and previous patient studies for download and review. Searchqueries can be made to the cloud server 12 that will allow the universalinterface software to quickly identify and retrieve relevant patientstudies and patient diagnostic images from a particular patient'slibrary stored on the cloud server. The common nomenclature focuses onthe type of radiological diagnostic imaging device that took the patientimage, the area of the human anatomy as well as many other factors suchas angle and automatically assigned anatomical terms. Search queriesmade to the cloud server 12 can identify relevant images based on any ofthe aforementioned tags. Thus diagnostic images can be located on thecloud server that are specific to a specific type of diagnostic imagingdevice, or images and patient studies can be located based upon the viewof the diagnostic image or even the anatomical sub-tags that areassigned by the universal interface software.

After the tagging step 62 and the automatic sub-tag assignment step 64 apatient study creation step 66 occurs where the written patientinformation or written report 96 prepared by the physician is saved intoa file referred to as a previous patient study 70 that includes thepatient name and date of the diagnostic images associated with theprevious patient study 70. At a keyword tagging step 97 the universalinterface software reads the written report and automatically generateskeyword tags 93 by recognizing anatomical language in the writtenreport. Then the universal interface software is used to complete thecreation of the previous patient study 70 file so that it furtherincludes the patient diagnostic image 86 or images, written report 96pertaining to the patient diagnostic image 86, image procedure tags 90,image view tags 92, keyword tags 93, automatically assigned sub-tags 64and the universal medical record number that is assigned by theuniversal interface software. The universal medical record number is acommon number that will be used to identify the patient library 72 onthe cloud server 12 and can be used among the different medicalinstitutes for purposes of billing as well as keeping all of theindividual patient images and patient study information within thepatient library 72 on the cloud server 12. The medical record number isassigned by the universal interface software when the patient diagnosticimage 86 is uploaded to the PACS at a final upload step 68.

During the final uploading step 68 the physician or other staff personat the medical institute using the workstation 22, 22′ saves the patientstudy file to the PACS 20 at the first medical institute 16 and uploadsthe patient study file 70 to the cloud server 12 either from the PACS 20or directly from the workstation 22, 22′ as part of the final uploadstep 68. The patient study file 70, which is also referred to as aprevious patient study file 70 is stored on the cloud server 12 in apatient library 72, which is contained within the data storage device 14connected to the cloud server 12.

Creating at least one comparison diagnostic image step 74 occurs at thesecond medical institute 28 where a physician or user creates acomparison patient diagnostic image 75 of the patient (same patient asmentioned above with respect to the first medical institute 16). Thecomparison patient diagnostic image 75 is a single image, however thereare typically several images that are prepared using the at least oneradiological diagnostic image device 32. The at least one comparisonpatient diagnostic image 75 is uploaded from the at least oneradiological diagnostic image device 32 to the PACS 30 of the secondmedical institute 28, also at this time the universal interface softwarewill assign an accession number that coordinates with the PACS 30 toensure reports are linked to the corresponding radiological images withsubsequent billing for services. Also assigned is the medical recordnumber relating to the patient diagnostic image 75 or images, which willbe incorporated into the patient study. The medical record number isuniversal to the particular patient and will correlate to their patientlibrary. The accession number also allows for all of the services andprocedures, including the radiologist's written report to be billedunder the assigned accession number. During an accessing step 76 thephysician or user uses the workstation 34, 34′ at second medicalinstitute 28 to access the at least one comparison patient diagnosticimage 75 located on the PACS 30 at the second medical institute 28.

Referring also to FIG. 4 a step of tagging 78 occurs, which is similarto the tagging step 62 that takes place at the first medical institute16, During tagging step 78 the at least one patient comparisondiagnostic image 75 is tagged when a physician or user of the at leastone workstation 34, 34′, uses a graphical user interface 77 located onthe first image monitor 38, second image monitor 40, voice recognitionmonitor 52, work list monitor 54 or cloud monitor 56; where theuniversal interface software displays selection windows where thephysician or user selects at least one image procedure tag 90′pertaining to nature of the image and how it was obtained including thefollowing types of diagnostic devices or modalities such as X-ray, CTscan, MRI, positron emission tomography (PET), mammograms (MG), computedradiography (CR) etc. It is within the scope of this invention for otherimage procedure tags to be listed. The universal interface software alsodisplays a selection window that allows the physician or user to operatethe graphical user interface 77 to select at least one image view tag92′ pertaining to the viewpoint of the at least one comparison patientdiagnostic image 75, which can be for example axial, sagittal reformats,coronal reformats, anterior/posterior, lateral, oblique, right, left,etc.

Next at a step 80 the universal interface software automatically assignsanatomical sub-tags 94′ to the at least one patient comparisondiagnostic image 75 using the universal interface software. During thestep 80 the universal interface software is programmed to assign theanatomical sub-tags based on the at least one image procedure tag 90′and the at least one image view tag 92′ selected by the physician oruser during the tagging step 78.

The anatomical sub-tags 94′ are visible or invisible tags that areassociated with each diagnostic image, which allow for an appropriateimage to be queried by the cloud server 12 based on several parametersincluding, but not limited to the device that the image was createdwith, angle of the viewpoint, anatomical features shown in the image andother automatically associated data that a physician or user may or maynot necessarily include in their own tagging of the image. For exampleif an image were to show the upper main body cavity a physician onlyreviewing the image for a problem in the area of the stomach organ mightnot necessarily tag the image as also showing portions of the organsnearby or any skeletal bones that are visible in the image. Theuniversal interface software is programmed to automatically assignanatomical sub-tags 94′ and will recognize or add tags to a particularimage based on the universal interface software being programmed toassign those sub-tags from the inputs selected by the physician or user.In other words the automatically assigned anatomical sub-tags 94′ helpto automate the tagging process without completely depending on thephysician or user selecting all the appropriate tags, which can becumbersome and also leave room for error.

With regard to the image procedure tags and image view tags at the firstmedical institute 16 and second medical institute 28, the at least oneimage procedure tag 90, 90′ and the at least one image view tag 92, 92′are selected from pre-populated fields that the user reviewing thediagnostic image selects prior to uploading the image onto the cloudserver 12. This allows for the universal interface software to thenautomatically assign anatomical sub-tags 94,94′ based on the at leastone image procedure tag and the at least one image view tag. Theautomatically assigned anatomical sub-tags 94, 94′ the at least oneimage procedure tag 90, 90′ and the at least one image view tag 92, 92′become part of the patient study, which allows for the patient library72 on the cloud server 12 to be automatically searched so that a user ofthe cloud server 12 can quickly and seamlessly locate and view specificpatient diagnostic images based on what the image shows and notnecessarily based upon the type of image or vice versa. For example auser of the cloud server can search the at least one patient library forimages showing portions of the specific patient's upper chest cavityregardless of the type of image (i.e., x-ray, CT scan, MRI scan).

After the physician or user has tagged the at least one comparisonpatient diagnostic image 75 and the universal interface software hasautomatically assigned anatomical sub-tags 94′, at a step 82 thephysician reviews the at least one comparison patient diagnostic image75 and performs a typical diagnostic imaging read where the physicianwill prepare a written report, which is typically dictated using thedictaphone 46, keyboard 48 and voice recognition monitor 52 portions ofthe work station 34, 34′.

Sometimes during the review step 82 the physician identifies anabnormality in the at least one comparison patient diagnostic image 75that requires further investigation. Typically diagnostic images do notcontain abnormalities that require further investigation, therefore atdecision step 81 a decision is made whether further patient historyreview or further studies are needed. For a majority of images furtherpatient history review may not be necessary, therefore if no furtherpatient history review or further studies are needed at step 83 a secondprevious patient study 70′ is prepared and uploaded to the cloud server12 in a manner identical or similar to the preparation of the previouspatient study 70 prepared at the first medical institute 16 describedabove. During step 83 a written report 96′ is prepared based on thecomparison diagnostic images 75 (now considered at least one patientdiagnostic image 75′). Then at a keyword tagging step 97′ the universalinterface software reads the written report and automatically generateskeyword tags 93′ by recognizing anatomical language in the writtenreport. Then the universal interface software is used to complete thecreation of the previous patient study 70′ file so that it furtherincludes the patient diagnostic images 75′ or images, written report 96′pertaining to the patient diagnostic images 75′, image procedure tags90′, image view tags 92′, keyword tags 93′, automatically assignedsub-tags 94′, a universal medical record number, and accession numberthat are assigned by the universal interface software. At step 100 theprevious patient study 70′ is uploaded to the cloud server 12.

If at step 81 an abnormality is found then further investigation istypically needed. Typically further investigation involves takingfurther diagnostic images and performing additional patient studies,even for abnormalities that might be somewhat minor. For example apatient might have a benign tumor or cyst that was noted at othermedical institutes. However unless a medical institute has some type ofdocumentation or point of reference additional studies are performed.The present invention provides the advantage that documentation andpoint of reference in the form of previous patient studies saved to thecloud server 12 are readily available to the physician and staff at thesecond medical institute 28.

Next during an accessing step 85 at least one patient diagnostic library72 on the cloud server 12 is accessed using the at least one workstation34, 34′ at the second medical institute 28. In performing the accessingstep 85 the physician will use the at least one workstation 34, 34′ tosend a request to the cloud server 12 to search the at least one patientlibrary 72 for any at least one patient diagnostic image 86 and aprevious patient study 70, which includes a written report, date of theat least one patient diagnostic image 86, patient name and otherinformation. The at least one patient diagnostic image 86 is identifiedbecause it contains the same anatomical sub-tags as the at least onecomparison patient diagnostic image 75. Next the matching at least onepatient diagnostic image 86 and its accompanying previous patient study70 are downloaded from the cloud server 12 to the PACS 30 or workstation34, 34′ of the second medical institute 28. After downloading thepatient diagnostic image 86 and the previous patient study 70 aphysician can optionally perform a review step 108 (FIG. 8B) which is adecision box that requests the physician to decide whether to submit anofficial or nonofficial communication of the previous patient study 70.If the physician performs review step 108 then the universal interfacesoftware will ask whether the review will be an official review atdecision box 110. If at decision box 110 an official review is to beconducted then an official review step 112 will take place and theofficial review will be submitted to the first medical institute 16 andor the patient library 72 on the cloud server 12.

Referring now to FIG. 6 is a screenshot of an official review form wherethe physician may decide whether to agree or disagree with theconclusions of the previous patient study 70. There is also a text boxwhere comments can be added and an image attachment portion where theimage preview or thumbnail is visible. If at decision box 110 it isdecided that an official review is not needed then at a non-officialcommunication step 114 the physician may send the first medicalinstitute or a physician at the first medical institute 16 an informalemail or non-official communication 39, as show in in FIG. 1. Anon-official communication step is sometimes more appropriate andhelpful if the physician at the second medical institute 28 has somesimple questions about the previous patient study, without necessarilyagreeing or disagreeing with the results of the previous patient study.The non-official communication step 114 is also helpful for informalcommunications independent of the previous patient study 70, for exampleif the physician at the second medical institute 28 knows the signingphysician at the first medical institute 16 and is seeking to simplysend a personal message then the non-official communication step 114would allow for such a communication.

If no review step 108 takes place or after the review step occurs, thenext step is a create comparison patient study step 87 where thephysician creates a comparison patient study 95 with a written report96″ comparing the at least one comparison patient diagnostic image 75and the at least one patient diagnostic image 86 including the previouspatient study 70 downloaded from the cloud server 12. The createcomparison patient study step 87 will also include a review of theabnormality noted during the review step 82. Once the comparison patientstudy 95 has been prepared at a keyword tagging step 97, the universalinterface software reads the written report 96″ and automaticallygenerates keyword tags 93″ by recognizing anatomical language in thewritten report. At an uploading step 102 the comparison patient study 95is uploaded to the PACS 30 at the second medical institute. Also at theuploading step 102 the comparison patient study is uploaded from thesecond medical institute 28 to the cloud server 12, which can originatefrom either the workstations 34, 34′ or from the PACS 30.

Referring also to FIG. 5, during the create comparison patient studystep 87 in FIG. 8B, the comparison patient study 95 is prepared usingthe first image monitor 38 and second image monitor 40 where theprevious patient diagnostic image 86 or comparison diagnostic image 75are displayed on one of the first image monitor 38 or second imagemonitor 40. On the first image monitor 38 or second image monitor 40 theat least one patient diagnostic image from the previous patient study isdisplayed so that a side-by-side comparison of the two images occurs.

FIG. 4 shows a timeline 98 is automatically created by the universalinterface software, wherein the timeline 98 arranges the date of thecomparison diagnostic image 75 or images and the date of the previouspatient diagnostic image 86 or images from the previous patient study 70into the timeline 98. At times there may be several previous patientstudies 70 with multiple images that are downloaded from the cloudserver 12, therefore the timeline 98 will help assist the physician inkeeping the various diagnostic images organized when carrying out thecomparison step and displaying the images side-by-side on the firstimage monitor 38 and second image monitor 40. The timeline 98 can bedisplayed on any one of the first image monitor 38, second image monitor40, voice recognition monitor 52, worklist monitor 54 and cloud monitor56. It is preferable the timeline be displayed on the worklist monitor54 or cloud monitor 56.

The description of the invention is merely exemplary in nature and,thus, variations that do not depart from the gist of the invention areintended to be within the scope of the invention. Such variations arenot to be regarded as a departure from the spirit and scope of theinvention.

What is claimed is:
 1. A system for creating more comprehensiveradiological reports and method of generating reports comprising:providing a medical institute having radiological diagnostic imagedevices that include one or more of ultrasound, computed tomography (CT)scan, magnetic resonance imaging (MRI), positron emission tomography(PET), mammograms (MG), computed radiography (CR), nuclear medicineimaging and dual energy X-ray absorptiometry, workstations and a picturearchiving and communication system (PACS) for creating a patient libraryand storing comparison patient diagnostic images and a previous patientstudy containing patient diagnostic images created or downloaded forreview at the medical institute, wherein each one of the workstationsincludes a first image monitor and a second image monitor both havinghigh resolution, wherein the first image monitor and the second imagemonitor are arranged in a side by side manner in order to assist thephysician in comparing the comparison patient diagnostic images and thepatient diagnostic images; providing a universal interface softwareoperating on PACS and accessible from the workstations for communicatingbetween the workstations and PACS at the medical institute and forstandardizing all information uploaded to PACS, the universal interfacesoftware interfaces between PACS and the workstations to send a requestPACS to search the patient library and retrieve the previous patientstudy containing patient diagnostic images that have the sameautomatically assigned anatomical sub-tags as automatically assignedanatomical sub-tags of comparison patient diagnostic images; providingimage procedure tags created by the universal interface software, wherethe image procedure tags relate to how the patient diagnostic images orcomparison patient diagnostic images were obtained and include the typeof radiological diagnostic image device or modalities used; providingimage view tags created by the universal interface software, where theimage view tags relate to the viewpoint of the patient diagnostic imagesor comparison patient diagnostic images; providing the automaticallyassigned anatomical sub-tags generated by the universal interfacesoftware based on the combination of the image procedure tags and theimage view tags, wherein the automatically assigned anatomical sub-tagsrelate to the different portions of the anatomy defined by the imageprocedure tags and the image view tags; providing keyword tags generatedby the universal interface software when the universal interfacesoftware reads a written report in the previous patient study or awritten report in a comparison patient study where the universalinterface software automatically generates the keyword tags byrecognizing anatomical language in a written report of the previouspatient study or a written report of a comparison patient study; whereinthe PACS stores the patient library using a format created by theuniversal interface software, thereby allowing the universal interfacesoftware to search the patient library stored on the PACS for theprevious patient study that includes written patient informationincluding patient name and date of study, the patient diagnostic images,the written report pertaining to the patient diagnostic images, imageprocedure tags pertaining to how the patient diagnostic images wereobtained, the image view tags pertaining to the viewpoint of the patientdiagnostic images, an automatically assigned universal medical recordnumber associated with the previous patient study, and automaticallyassigned anatomical sub-tags; creating at the medical institute thecomparison patient diagnostic images of the patient using theradiological diagnostic image devices and uploading the comparisonpatient diagnostic images to the PACS at the medical institute; usingone of the workstations at the medical institute to access thecomparison patient diagnostic images located on the picture archivingand communication system at the medical institute, tagging the patientcomparison diagnostic images by a user of the one of the workstations atthe second medical institute using a graphical user interface and theuniversal interface software to select the image procedure tagspertaining to how the comparison patient diagnostic images were obtainedand the image view tags, wherein the image view tags pertain to theviewpoint of the patient diagnostic images; automatically assigning withthe universal interface software, the automatically assigned anatomicalsub-tags and a universal medical record number to the comparison patientdiagnostic images, wherein the image procedure tags, the image view tagsand the automatically assigned anatomical sub-tags selected during thestep of tagging are prepopulated to provide a common softwarenomenclature; reviewing by a user the comparison patient diagnosticimages and identifying an abnormality in the comparison patientdiagnostic images that require further investigation; accessing by theuser using the one of the workstations and using the universal interfacesoftware to send a search request to the PACS to search the patientlibrary for any patient diagnostic images containing the same saidautomatically assigned anatomical sub-tags as the comparison patientdiagnostic images and downloading from the PACS to the one of theworkstations the previous patient study and patient diagnostic imagesmatching the search request; using the universal interface software toautomatically link the universal medical record number from the previouspatient study to the universal medical record number of the comparisonpatient study; creating the comparison patient study including a writtenreport, prepared by the user, comparing the comparison patientdiagnostic images and the previous patient study including the patientdiagnostic images downloaded from the PACS, wherein the written reportbecomes part of said comparison patient study and includes a review ofthe abnormality noted in the comparison patient diagnostic images andthe presence or absence of the abnormality in the previous patient studyand the patient diagnostic images downloaded from the PACS; performing akeyword tagging step wherein the universal interface software reads thewritten report and automatically generates keyword tags by recognizinganatomical language in the written report of the comparison patientstudy, wherein the keyword tags become part of the comparison patientstudy; and uploading the comparison patient study to the patient libraryon the PACS using the universal interface software.
 2. The system ofclaim 1 wherein the step of creating the comparison patient studyfurther includes organizing the patient diagnostic images from theprevious patient study downloaded from the PACS and the comparisonpatient diagnostic images into a timeline on the one of the workstationsof the medical institute, where said patient diagnostic images and thecomparison diagnostic images are reviewed in a side by side comparisonto conduct further investigation of the abnormality noted in thecomparison patient diagnostic images.
 3. The system of claim 1 furthercomprising the step of: choosing between an official peer review ofprevious patient study downloaded from the PACS as part of thecomparison study or a non-official communication.
 4. The system of claim3 further comprising the steps of: selecting an official peer review;accessing the written report of the previous patient study downloadedfrom the PACS and drafting a second written report regarding thefindings of the patient, which includes physician contact information.5. The system of claim 3 further comprising the steps of: selectingnon-official communication; opening a communication screen used forcontacting a physician that performed the previous patient study,wherein the communication screen is not documented in the previouspatient study and does not constitute an official written report.
 6. Thesystem of claim 1 further comprising the steps of: providing the patientwith access to the patient library using a personal computer connectedto the PACS and allowing a user of the personal computer to uploadprevious radiological images in their possession into the patientlibrary.
 7. The system of claim 1 further comprising the steps of:providing a compact disc containing a manual patient study that includeswritten patient information including patient name and date of study,the manual patient study file includes patient diagnostic images;loading the manual patient study from the compact disc onto theworkstations at the medical institute, wherein the manual patient studyis viewed on the one of the workstations; creating a second opinionstudy file using the one of the workstations at the second medicalinstitute, wherein the second opinion study file includes patient name,date of second opinion study, all information from the manual patientstudy and patient diagnostic images from the manual patient study;viewing the patient diagnostic images from the manual patient studytagging the patient diagnostic images from the manual patient study by auser of the one of the workstations, using a graphical user interfaceand the universal interface software to select the image procedure tagspertaining to how the diagnostic images from the manual patient studywas obtained; automatically assigning anatomical sub-tags and auniversal accession number to said patient diagnostic images from themanual patient study, wherein said universal interface software isprogrammed to assign the anatomical sub-tags based on the imageprocedure tags and the image view tags; reviewing the patient diagnosticimages from the manual patient study and preparing a written report thatwill become part of the second opinion study file prepared by a userafter reviewing the patient diagnostic images from the manual patientstudy; saving the second opinion study onto PACS at the medicalInstitute.
 8. A system for creating more comprehensive radiologicalreports and method of generating reports comprising: providing a medicalinstitute having radiological diagnostic image devices that include oneor more of X-ray radiograph, computed tomography (CT) scan, magneticresonance imaging (MRI), positron emission tomography (PET), mammograms(MG), computed radiography (CR), workstations and a picture archivingand communication system (PACS) for creating a patient library andstoring comparison patient diagnostic images and a previous patientstudy containing patient diagnostic images created or downloaded forreview at the medical institute, wherein each one of the workstationsincludes a first image monitor and a second image monitor both havinghigh resolution, wherein the first image monitor and the second imagemonitor are arranged in a side by side manner in order to assist thephysician in comparing the comparison patient diagnostic images and thepatient diagnostic images; providing a universal interface softwareoperating on PACS and accessible from the workstations for communicatingbetween the workstations and PACS at the medical institute and forstandardizing all information uploaded to PACS, the universal interfacesoftware interfaces between PACS and the workstations to send a requestPACS to search the patient library and retrieve the previous patientstudy containing patient diagnostic images that have the sameautomatically assigned anatomical sub-tags as automatically assignedanatomical sub-tags of comparison patient diagnostic images; providingimage procedure tags created by the universal interface software, wherethe image procedure tags relate to how the patient diagnostic images orcomparison patient diagnostic images were obtained and include the typeof radiological diagnostic image device or modalities used; providingimage view tags created by the universal interface software, where theimage view tags relate to the viewpoint of the patient diagnostic imagesor comparison patient diagnostic images; providing the automaticallyassigned anatomical sub-tags generated by the universal interfacesoftware based on the combination of the image procedure tags and theimage view tags, wherein the automatically assigned anatomical sub-tagsrelate to the different portions of the anatomy defined by the imageprocedure tags and the image view tags; providing keyword tags generatedby the universal interface software when the universal interfacesoftware reads a written report in the previous patient study or awritten report in a comparison patient study where the universalinterface software automatically generates the keyword tags byrecognizing anatomical language in a written report of the previouspatient study or a written report of a comparison patient study; whereinthe PACS stores the patient library using a format created by theuniversal interface software, thereby allowing the universal interfacesoftware to search the patient library stored on the PACS for theprevious patient study that includes written patient informationincluding patient name and date of study, the patient diagnostic images,the written report pertaining to the patient diagnostic images, imageprocedure tags pertaining to how the patient diagnostic images wereobtained, the image view tags pertaining to the viewpoint of the patientdiagnostic images, an automatically assigned universal medical recordnumber associated with the previous patient study, and automaticallyassigned anatomical sub-tags; creating at the medical institute thecomparison patient diagnostic images of the patient using theradiological diagnostic image devices and uploading the comparisonpatient diagnostic images to the PACS at the medical institute; usingone of the workstations at the medical institute to access thecomparison patient diagnostic images located on the picture archivingand communication system at the medical institute, tagging the patientcomparison diagnostic images by a user of the one of the workstations atthe second medical institute using a graphical user interface and theuniversal interface software to select the image procedure tagspertaining to how the comparison patient diagnostic images were obtainedand the image view tags, wherein the image view tags pertain to theviewpoint of the patient diagnostic images; automatically assigning withthe universal interface software, the automatically assigned anatomicalsub-tags and a universal medical record number to the comparison patientdiagnostic images, wherein the image procedure tags, the image view tagsand the automatically assigned anatomical sub-tags selected during thestep of tagging are prepopulated to provide a common softwarenomenclature; reviewing by a user the comparison patient diagnosticimages and identifying an abnormality in the comparison patientdiagnostic images that require further investigation; accessing by theuser using the one of the workstations and using the universal interfacesoftware to send a search request to the PACS to search the patientlibrary for any patient diagnostic images containing the same saidautomatically assigned anatomical sub-tags as the comparison patientdiagnostic images and downloading from the PACS to the one of theworkstations the previous patient study and patient diagnostic imagesmatching the search request; using the universal interface software toautomatically link the universal medical record number from the previouspatient study to the universal medical record number of the comparisonpatient study; creating the comparison patient study including a writtenreport, prepared by the user, comparing the comparison patientdiagnostic images and the previous patient study including the patientdiagnostic images downloaded from the PACS, wherein the written reportbecomes part of said comparison patient study and includes a review ofthe abnormality noted in the comparison patient diagnostic images andthe presence or absence of the abnormality in the previous patient studyand the patient diagnostic images downloaded from the PACS; performing akeyword tagging step wherein the universal interface software reads thewritten report and automatically generates keyword tags by recognizinganatomical language in the written report of the comparison patientstudy, wherein the keyword tags become part of the comparison patientstudy; accessing the PACS and choosing between an official peer reviewof the previous patient study as part of the comparison study or anon-official communication; and uploading the comparison patient studyto the patient library on the PACS using the universal interfacesoftware.
 9. The system of claim 8 further comprising the steps of:selecting non-official communication; opening a communication screenused for contacting the physician that performed the previous patientstudy, wherein the communication screen is not documented in theprevious patient study and does not constitute an official writtenreport.
 10. The system of claim 8 wherein the step of creating thecomparison patient study further includes organizing the patientdiagnostic images from the previous patient study downloaded from thePACS and the comparison patient diagnostic images into a timeline on theone of the workstations of the medical institute, where said patientdiagnostic images and the comparison diagnostic images are reviewed in aside by side comparison to conduct further investigation of theabnormality noted in the comparison patient diagnostic images.
 11. Thesystem of claim 8 further comprising the steps of: providing the patientwith access to the patient library using a personal computer connectedto the PACS and allowing a user of the personal computer to uploadprevious radiological images in their possession into the patientlibrary.
 12. The system of claim 8 further comprising the steps of:providing a compact disc containing a manual patient study that includeswritten patient information including patient name and date of study,the manual patient study file includes patient diagnostic images;loading the manual patient study from the compact disc onto theworkstations at the medical institute, wherein the manual patient studyis viewed on the one of the workstations; creating a second opinionstudy file using the one of the workstations at the second medicalinstitute, wherein the second opinion study file includes patient name,date of second opinion study, all information from the manual patientstudy and patient diagnostic images from the manual patient study;viewing the patient diagnostic images from the manual patient studytagging the patient diagnostic images from the manual patient study by auser of the one of the workstations, using a graphical user interfaceand the universal interface software to select the image procedure tagspertaining to how the diagnostic images from the manual patient studywas obtained; automatically assigning anatomical sub-tags and auniversal accession number to said patient diagnostic images from themanual patient study, wherein said universal interface software isprogrammed to assign the anatomical sub-tags based on the imageprocedure tags and the image view tags; reviewing the patient diagnosticimages from the manual patient study and preparing a written report thatwill become part of the second opinion study file prepared by a userafter reviewing the patient diagnostic images from the manual patientstudy; saving the second opinion study onto PACS at the medicalInstitute.